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Name: HARLOW PCG
Date: 03 Aug 2000
Time: 19:40:45
HARLOW PRIMARY CARE GROUP
OPEN PUBLIC BOARD MEETING
THURSDAY 6 JULY 2000 MINUTES OF THE OPEN PUBLIC BOARD MEETING HELD IN THE COUNCIL CHAMBERS, HARLOW COUNCIL, TOWN HALL
Chairperson: Dr Cliff Bishop
Present: Dr Cliff Bishop Sally Gorham Dr John Portelly Irene Jein Dr Rob Gerlis Dr Mukesh Rajani Dr Hassan Khimji Dr Trevor George Councillor Roy Collier Apologies: Peter Pearson Rita Cutts John Wright Matthew White In Attendance: Fiona Gilmour Alan Cudmore Anne Reeder Paul Wrighter Stephen Robinson Adrian Thrower Siobhan Jordan Joyce Sweeney
ACTION 57/00 WELCOME AND INTRODUCTIONSDr Cliff Bishop welcomed Councillor Roy Collier to his first meeting as an associate member of the Board, representing Harlow District Council. 58/00 PRESENTATION BY STEPHEN ROBINSON - WALK-IN CENTRE PROJECT MANAGERStephen Robinson introduced himself and began his presentation by updating the meeting on the national position on walk-in centres. He explained walk-in centres were introduced as part of the NHS Modernisation programme. When Harlow had originally submitted their bid to have a walk-in centre, it was very much an open book. Since then guidelines for walk-in centres have been developed and their role clarified including the core services that are to be provided at the centres. Walk-in Centres are to be nurse led and it is expected that 50-60% of transactions will be completed within the walk-in centre and approximately 40% referred on to other services. Although Walk-in centres will have to conform with the National guidance, it is recognised that they will be configured in different ways to meet local needs and to ensure that they integrate with other local services. There is still an opportunity to 'learn as you go' and inform the national scene.Stephen Robinson then went on to talk about the local position. Harlow is unique in having a walk-in centre based on three sites; The Young People's Information Centre, The Main Centre at the Ambulance Station and the Healthy Living Centre known as 'Wellness Wheels'. Stephen Robinson referred the meeting to his report in the Board papers, which gives more details of the centres and confirmed that the main site will open at the end of July. Stephen Robinson then tabled a further report giving details of the recruitment of nursing and administrative staff and the expenditure. It was noted that the budgets do not include £90,000 local contribution (i.e. rent and management time) He reported that the work on the ambulance station was virtually complete and would be finished in time for the opening. The IT systems being installed are standard Window packages, Night Owl to be used by the Admin staff for patient registration and Centramax for patient triaging to be used by the nurses. Publicity is in hand with an open day for professionals, leaflets (branded by the Centre), talks to local groups, radio, etc. It is proposed to build the service up slowly with restricted opening hours for the first few weeks becoming fully operational by the official opening in September.Stephen Robinson explained that the original plans to have three doctors working at the Walk-in Centre had had to be modified following direction from the Centre. It was now proposed to employ 1wte GP to provide clinical leadership, targeted clinical sessions and to liase with other local services to ensure that the walk-in centre is integrated within the local economy. Funding for a further WTE GP post would be used to buy specific services from local GPs or organisations for advice and support.Evaluation of the project will be carried out by Essex University who will be looking specifically at the outcomes of the local service. Stephen Robinson acknowledged the effort and work of everyone involved locally and invited questions.Dr Rob Gerlis asked who would be responsible for patients referred to GPs by the WIC if they did not turn up. Stephen Robinson agreed that this required further work although NHS Direct guidance was proving helpful. A general discussion followed about the legal implications, the increased workload generated in following up people who do not attend and the importance of ensuring that patients understand the implications of advice given to them. It was doted that systems were in place through Centramax to confirm that patients understood the advice given to them. It was also agreed that it further work in this area was required although initially the WIC would not be referring on.Dr John Portelly raised the GPs' concerns about increased workload. Stephen Robinson confirmed that evidence from Sheffield and from NHS Direct's work with Cheldoc did not indicate any increase in workload for the GPs. Concern remained about emergency care and people attending for treatment at an inappropriate time and place. The public may expect to see a GP at the WIC and may go there if they cannot get an early appointment with their own GP. There was particular concern about prescribing emergency antibiotics. It was agreed that it was important to give the right messages to the public. It was also recognised that there will always be unexpected public behaviour and the WIC will have to work closely with other organisations to ensure that patients go to the right place. Irene Jein noted that clinical accountability will initially be with EHCT.Dr Mukesh Rajani reminded the meeting that the nurses were highly skilled and that Group Directives for prescribing would be developed.Siobhan Jordan was invited to comment. She confirmed that lists of drugs and group directives were being produced. These were likely to include antibiotics but would need careful work and consultation. It was suggested that regular meetings between the WIC and GPs would be useful. It was also noted that work was going on to rationalise the use of antibiotics across the town and that the WIC should be included.Dr Trevor George asked about people not registered with a GP. Siobhan stated that people would be assisted to register. Dr Rob Gerlis asked if people from outside Harlow would be seen. He was advised that although it had been intended that the centre was just for Harlow, other people would not be turned away. Neighbouring Health Authorities and Health providers would be given information about the centre and costs would be monitored. 59/00 MINUTES OF THE MEETING HELD ON 1 JUNE 2000The minutes were agreed as correct subject to the following amendments: 33/00 Poisons and injuries should be toxicology Portion should be proportion Add a coma between oral and gynaecology. 60/00 MATTERS ARISING199/99 GP Tutor PostSally Gorham has approached EQUIP to see if they would be interested in providing this service for the rest of the year, using the funds held by the Postgraduate Dean. A positive response has been received from John Guy at EQUIP who has agreed that EQUIP will organise the lunch time sessions and to provide someone to meet individually with each Harlow GP to discuss their Personal Development Programme. It was noted that this work needs to be linked to clinical governance. 37/00 National Primary Care Collaborative ProjectDavid Tregunno has been appointed as the Project Manager for the Harlow scheme and is due to start in September. A number of people attended the National workshop the project held in Cheltenham on June 22. Dr John Portelly explained that he had had concerns about the project but since attending the workshop was now very supportive. The three aims of the project had been clarified and now he has more information about the project, Dr Portelly felt that it could be a new way to improve local services. There was a good exchange of ideas from across the country which can be shared with the five practices participating from Harlow. He anticipates that it will generate a lot of work but is keen to get started. Sally Gorham confirmed that the PCG would be setting up a meeting for the five practices but that the project did not officially start until September. Dr Trevor George noted the need for secondary care to change too.It was suggested that we needed baseline information in order to measure improvement. It was noted that the Walk-in Centre would contribute to patient access to services.47/00 Quarter Four Annual Accountability AgreementA very positive meeting was held last week to review last year's Accountability Agreement and agree this year's agreement. The meeting looked at workforce planning, funding capitation formula, prescribing budgets and noted the disadvantaged position of Harlow. Concerns about the Acute Trust's capacity to meet demand and the effects of this on the performance fund were expressed. 61/00 MAKE A DIFFERENCE TO HARLOW EVENTThe event took place on Friday and Saturday and was very successful. The NHS Harlow PCG, PAH and EHCT) had joint stands with Environmental Health Department and the Harlow Sports Centre Trust. The theme was summer holidays and issues covered included sun safety, smoking cessation, health eating and sexual health. 62/00 WINTER PLANNINGWork has started to plan for winter 2000/01. Anne Reeder is the lead for the PCG. 63/00 ADDITIONAL FUNDING FOR PRIMARY CAREThe PCG is expecting approximately £70,000. The PCG are required to direct funding towards:§ Access to GPs and Primary Care § Reducing long waiting times§ Intermediate careThere is also likely to be a strong steer towards elderly people and care in the community.Dr Trevor George expressed concern about the recent PAHT red alert which was said to be due to the high number of elderly people waiting to be discharged. Joyce Sweeney from Social Services explained that although there had been a number of major recruitment drives for older people's services, they were still not fully recruited. This had created a backlog of patients waiting to be assessed. It is a National problem but grater in Harlow. Sally Gorham commented that at a recent local workshop, the voluntary sector did not appear to have the same recruitment problems and the PCG would be exploring this. Dr Rob Gerlis suggested that nurses could also assess and the main problem could be funding. The issues of who can assess was discussed and work is being carried out to resolve this. Dr Trevor George asked if figures were available showing how the number of secondary care beds available in Harlow compared with the national average and what the work force planning arrangements were. Alan Cudmore noted that people working in the voluntary sector did so from choice and expressed concern about the joint funding arrangements. Fiona Gilmour noted that a few years ago West Essex did not have this problem of delayed discharges but the position now appears to have been reversed with other parts of the county having fewer problems. It was suggested that the West build on their successes and noted that the Harlow position has improved with through Collaborative Care, which was based on schemes from North East Essex. The Harlow PCG Elderly Forum which is being established should help and it was suggested that Dr Bansal should be the GP representative although the Board should also have representation on the group. AR 64/00 NICE UPDATEAwaiting the definitive guidance on Beta Interferon. 65/00 CANCER SERVICESThe consultation period has been extended to September. It is proposed to hold a number of meetings and presentations for the public. This will include training Community Leaders so that they can lead local meetings. 66/00 CHEST PAIN CLINICThe joint PAHT/Harlow PCG bid for funding a rapid access chest pain clinic has been successful. £80,000has been awarded for Equipment and staffing to enhance the clinic at PAH and the Walk-in Centre. 67/00 SOCIAL SERVICES MANAGEMENT REVIEWSally Gorham has received a letter from the Director of Social Services informing the PCG that Essex Social Services are carrying out a management review. It is hoped that new arrangements will reflect the new working relationships with PCG/Ts. 68/00 ZYBANPreliminary guidelines have been sent to practices advising that Zyban should only be prescribed to people actively involved in smoking cessation groups. Groups had been planned to start in Harlow in September. The NEHA smoking advisor has now informed the PCG that the first group he will be running in should be starting in Harlow is not until January. After discussion it was agreed that rather than delay till then, the PCG would arrange additional courses to start in September. At present, there is no additional funding for prescribing but additional funds may be announced in four weeks as part of the National Plan. RC/SD 69/00 VERBAL DECLARATION OF INTERESTS BY BOARD MEMBERSNEHA auditors recommended the PCG Business Manager that a verbal declaration of interests was the preferred approach to registering interests. Sally Gorham explained the reasons for making declarations of both interests and hospitality. Dr Cliff Bishop asked the meeting if they for their views and after a brief discussion it was agreed to make both declarations.Each member of the Board present then made a verbal declaration of their interests. It was agreed that a letter should be sent to those Board members not present asking them to give a verbal declaration at the next Board meeting.Dr Cliff Bishop – Chairperson§ Partner at ‘The Hamilton Practice’§ Road Traffic Medical’s§ GP adviser to sub aqua clubDr Mukesh Rajani § Partner at ‘Lister House Medical Centre’§ Medical Director Essex & Herts Community Trust§ Symonds Nursing Home – Total 26% interest in nursing home including wife’s shares§ Trustee of St Claire’s Hospice§ Surveys - £400 eachDr Arvind Chhibber§ Partner at ‘Nuffield House’§ Chair/Director of Harlow Doctors on Call (co-op)Sally Gorham§ Board member of Harlow CollegeDr John Portelly§ Partner at ‘The Ross Practice’§ Chair of Harlow Medical SocietyDr Rob Gerlis§ Partner at ‘The Ross Practice’§ RTA Medical’s§ Manages Youth Football TeamDr Hassan Khimji§ Partner at ‘The Vanner & Partners Practice’§ Edu/spec Councillor Roy Collier§ Elected member of Harlow District Council§ Anglia Association Irene Jein (Written declaration to be provided)Matthew White (Written declaration to be provided)John Wright (Written declaration to be provided)Rita Cutts (Written declaration to be provided) 70/00 VERBAL DECLARATION OF HOSPITALITY RECEIVEDBoard members then declared hospitality received this year. It was acknowledged that it was difficult to recall in retrospect and suggested that a regular record be kept by the PCG.Dr Cliff Bishop§ One meal paid for by Drug CompanyDr Mukesh Rajani§ Two meals paid for by Drug Company’s§ Educational meeting at Nuffield§ £150 for chairing meetingSally Gorham§ no hospitality receivedDr John Portelly§ Four meals paid for by Drug company’s§ Brands Hatch tickets paid for by Drug CompanyDr Rob Gerlis§ Two meals paid for by Drug Company’sDr Hassan Khimji§ Lunch sponsored by Drug Company 71/00 PROGRESS REPORT ON HIMPDr Arvind Chhibber presented his paper from the Board papers. He then drew the meeting's attention to the NEHA Annual Public Health Report which had been previously copied to all GPs. Dr Chhibber presented key elements from the report including statistics and target figures for each PCG/T on reducing death rates. There was concern that the figures for Harlow were unrealistic and Dr Chhibber agreed to pass on the Board's comments to NEHA including their gross reservations about the figures. AC 72/00 INTERMEDIATE CARE SERVICES – ACTION PLANAnne Reeder presented her paper from the Board papers. She explained that the health Authority had identified intermediate care and delayed discharges as a priority area and required each health sub economy to produce an action plan of schemes to improve the situation. The West Essex plan was made up of each PCG/T's plans.The Harlow plan was based on the ideas generated through the recent Harlow workshops. The proposal to establish a one-stop shop was questioned as many elderly people were not mobile. Anne Reeder explained that the proposal would include a telephone helpline recognising this problem.Rob Gerlis raised the issue of transport. Sally Gorham explained that transport was being discussed and reviewed through a separate West Essex Transport Group with the hope of working more closely with other transport providers and users to improve the service. 73/00 FINANCE REPORT YEAR TO DATEPaul Wrighter presented the finance paper. He explained that it includes budget adjustments. He pointed out that the budget currently includes St Francis Hospice. This is for one year only while the transfer of both resources and referrals to St Clare's Hospice takes place. Paul confirmed that the £63 relates to a half-year payment to St Francis. 74/00 PRESCRIBING ISSUESAnne Reeder reported that the PPA figures for January are predicting a year end overspend for Harlow of 9.06%. The Health Authority have done a comparison of December’s figures by PCG/T which show that Harlow is performing comparatively well in most areas of prescribing although the level of overspend remains a concern.A draft outline plan for the influenza vaccination programme has been submitted to the Health Authority. The advice service from PAH has started. The service has been asked to review high cost drugs and to analyse the new communication forms as they come into the PCG.The Harlow formulary was discussed. It was agreed that it would be useful to have the formulary on the Unified Clinical system but acknowledged that it would involve a considerable amount of work. Dr Arvind Chhibber and Dr Rob Gerlis have already done a quick review of the formulary. It was noted that it was on the agenda of the next Medicines Management Sub-Committee where the format and the methods for maintaining, updating and developing the formulary would be discussed. 75/00 THE DATA PROTECTION ACTDr Mukesh Rajani presented the paper explaining that the Data Protection Act had already come into force on 1 March 2000. Dr Rajani emphasised the importance of the act and of ensuring that all staff are fully aware. He recommended the simple do's and don'ts sheet attached to the papers. It was agreed that Ann Reeder should ask the Practice Managers to ensure that everyone in their practice is familiar with the Act. AR 76/00 ACTION TAKEN BY THE CLINICAL/MANAGEMENT EXECUTIVEThe correspondence relating to the mental health services in West Essex was noted as a public record. The CHC stated that they were pleased to see that progress appears to be being made in this area.Dr Cliff Bishop informed the meeting that the waiting list initiative had also been discussed at length by the Clinical/Management Executive. The discussion had concluded that there were concerns about perusing this route. However since the discussion it appeared that several practices were still interested in the initiative. It was noted that not all the data required to make informed decisions was available and so the majority view was that although it was acknowledged that there were serious reservations, final decisions should be made by each practice when all the information is available. At this point the meeting was no longer quorate and Dr Bishop closed the meeting at 1.05p.m
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